Privacy Notice
This privacy notice is being provided to you as a requirement of the federal government as of April 14, 2003. The Health Insurance Portability and Accountability Act.

Summary of Privacy Practices
This is a summary of the ways Atlanta Diabetes Associates may use and share your Protected Health Information without your specific written permission and of your rights with regard to your Protected Health Information.

Use or Disclosure Authorization
This form is an authorization form that you sign that tells Atlanta Diabetes Associates who they may disclose your protected health information to and acknowledges that you have read and understand our privacy notice. At your initial visit you are asked to sign this notice.

Frequently Asked Questions
This is a list of frequently asked questions about The Health Insurance Portability and Accountability Act of April 2003.

Frequently Asked Questions About HIPAAIn the constantly changing healthcare environment, our practice is committed to educating our patients about healthcare issues that affect them. As a result, we have provided below general information about the Health Insurance Portability and Accountability Act of 1996(HIPAA) for your review. Our practice is complying with HIPAA’s regulations and would be happy to answer any additional questions you might have.

What is the Privacy Rule?The Privacy Rule is part of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The Privacy Rule establishes a federal requirement that doctors, hospitals or other healthcare providers and health plan obtain a patient’s written consent before using or disclosing a patient’s personal health information to carry out treatment, payment or healthcare operations.

Atlanta Diabetes Associates is required by law to be complaint with the Privacy Rule by April 14, 2003.

What is PHI?

PHI or protected health information means any personal health information as defined by law, including demographic information that is collected from a patient by a healthcare provider or other entity that could potentially identify the individual. PHI includes all medical records and other individually identifiable health information held or disclosed by Atlanta Diabetes Associates regardless of how it is communicated (e.g. electronically, written, verbally).

What is TPO?

TPO refers to the treatment, payment or healthcare operations of Atlanta Diabetes Associates.

In other words, our practice can use or disclose PHI for performing any activity that it deems necessary for 1) providing quality patient care, 2) ensuring that our practice gets paid for services, and 3) operating our practice. Some examples of these activities are use of PHI by the physicians and clinical staff to treat a patient, use of PHI by the business office staff to verify insurance information for billing purposes, use of PHI to obtain a referral, and use of PHI for our practice’s business planning and internal management activities.

Why Do I have to Sign a Consent Form?

In order to use or disclose your PHI, our practice is required to obtain a signed consent form from you to directly treat you or carry out healthcare payment and operations activities. Our practice is NOT REQUIRED to obtain your prior consent in an emergency, when our practice is required by law to treat you, or when there are substantial communication barriers. Our practice reserves the right to refuse to treat you if you do not sign the consent form.

What is the Difference between the Consent and Authorization Forms?

In order to use or disclose your PHI for specified purposes other than direct treatment, payment, or healthcare operations, our practice is required to obtain a signed authorization form from you. For example, if you request our practice to disclose PHI to a third party, you must sign an authorization form. This authorization form is more detailed than a consent form and has a specific expiration date.